Urinary Incontinence in Women

Urinary incontinence is the leakage of small amounts of urine due to loss of bladder control. Urinary incontinence is a common women's health issue that can profoundly impact quality of life. There are many treatment options available to improve bladder control.

Two common types of urinary incontinence include:

Stress incontinence. Loss of urine when coughing, laughing or sneezing, or when walking, running, lifting heavy objects or exercising. This is the most common type of incontinence in younger women.

Urge incontinence. Sudden strong urge to void and urine leakage before reaching the toilet; also called overactive bladder.

There are many possible causes of urinary incontinence, including:

• Urinary tract infections
• Urinary tract abnormalities, such as a fistula, an abnormal opening from the urinary tract into another part of the body, such as the vagina, allowing urine to leak into that organ
• Medications
• Abnormal growths, such as polyps or bladder stones
• Poor muscle function. Childbirth, neuromuscular disorders, and other conditions can affect the proper function of the valve-like muscles that control the release of urine (urinary sphincter), which normally stay closed or contracted.
• Neuromuscular problems preventing signals from the brain and spinal cord from connecting properly with the bladder and urethra, the tube that carries urine from the body

Factors that may worsen symptoms or increase the likelihood of developing stress incontinence include:

• Age
• Childbirth
• Obesity
• Illnesses that cause chronic coughing or sneezing
• Smoking, which can cause frequent coughing
• Diabetes, which can cause excess urine production and nerve damage
• Excess consumption of caffeine or alcohol

Diagnosis starts with a detailed medical history and thorough physical exam, including a pelvic exam. You may be asked to keep a voiding diary to record how much urine is leaking, how often, what you were doing at the time, fluids consumed and other details.

Treatment depends on the type of incontinence and the individual patient. Treatment strategies include:

Behavioral therapies. To help patients know why leaks occur and how to avoid them

Lifestyle changes. Including weight loss, dietary changes, modified fluid intake, and no smoking

Muscle strengthening. To strengthen the pelvic floor and sphincter muscles through Kegel exercises

Medications.

Bladder training. To help gain awareness and control of your pelvic muscles

Sacral nerve stimulation. Sends mild electrical pulses to the sacral nerve, the nerve that influences bladder control muscles

Injectable urethra bulking agents. Injected into the tissues around the urethra to add bulk and narrow the urethra, decreasing leakage

Reconstructive surgery. To support the urethra and improve closure of the sphincter. Surgical options include sling procedures to support the urethra, and a surgically implanted artificial sphincter.

Healthy lifestyle habits may help prevent or ease the symptoms of stress incontinence, including:

• Exercise to make your muscles stronger
• Maintain a healthy weight
• Eat plenty of fiber (to prevent constipation and the strain it places on pelvic floor muscles)
• Limit or avoid caffeinated and alcoholic beverages
• Stop smoking